Medicine: Healthcare System

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Where Is The Healthcare Money Going ?

August 5, 2012

inMedicine: Healthcare System, Stakeholder Abuse of the Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.,FACP,MACE

The article in the Dallas Morning News on Sunday, July 29,2012 entitled “Your Doctor’s Big Fat Paycheck” by Eli Lehrer is misleading. The article ignores the real cause of the rising costs in the healthcare system.

Physicians are the easiest stakeholder to criticize because they are the least organized and least represented. This makes them the easiest and most vulnerable target.

The subtitle is “High wages in the medical sector are the underlying cause of ballooning healthcare costs.”

Eli Lehrer does a disservice to the medical profession as well as to patients. It does not represent the truth-value added effect of a physician's services to patients.

Mr. Lehrer article devalues physicians’ services. He has a lack of understanding of the costs of medical care vs. healthcare.

He quotes the Bureau of Labor statistics saying that primary care physicians earned just over $200,000 a year while specialists earned $355,000 per years in 2010. The Bureau of Labor Statistics used Medical Group Management Association (MGAMA) data for this estimate.

Those numbers are pretty close to the numbers reported by MGMA physician Compensation and Production Survey for 2011.

The number needs some correction but it is unnecessary to quibble.

The MGMA has a group of consultants that teach physicians how to make more money from the healthcare system.

Physician Compensation

Median compensation levels for primary and specialty care physicians

Source: MGMA Physician Compensation and Production Survey: 2012 Report Based on 2011 Data

http://www.mgma.com/physcomp/

http://www.bls.gov/oco/ocos074.htm#earnings

Anesthesiology $407,292

General surgery $343,958

Obstetrics/gynecology $281,190

Internal medicine $205,379

Psychiatry $200,694

Pediatrics/adolescent medicine $192,148

Family practice (without obstetrics) $189,402

Quick Facts: Physicians and Surgeons
2010 Median Pay	This wage is equal to or greater than $166,400 per year or $80.00 per hour.
Entry-Level Education	Doctoral or professional degree
Work Experience in a Related Occupation	None
On-the-job Training	Internship/residency
Number of Jobs, 2010	691,000
Job Outlook, 2010-20	24% (Faster than average)
Employment Change, 2010-20	168,300

The MGMA summarize physicians scope of work layman’s terms on its web site.

What Physicians and Surgeons Do

"Physicians and surgeons diagnose and treat injuries and illnesses in patients. Physicians examine patients, take medical histories, prescribe medications, and order, perform, and interpret diagnostic tests. Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.

Work Environment

Many physicians work in private offices or clinics, often helped by a small staff of nurses and other administrative workers. Surgeons and anesthesiologists usually work in sterile environments while performing surgery and may stand for long periods.

How to Become a Physician or Surgeon

Almost all physicians complete at least 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on their specialty.

Pay

Wages of physicians and surgeons are among the highest of all occupations. According to the Medical Group Management Association, physicians practicing primary care received total median annual compensation of $202,392, and physicians practicing in medical specialties received total median annual compensation of $356,885 in 2010."

http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2011/11/where-is-the-healthcare-money-going.html

I am temped to answer Mr. Lehrer’s article point by point. There is so much misinformation and disinformation in this article that it makes Yellow Journalism look tame.

The more important issues are how much does the healthcare system cost and where is the money going?

Then, and only then, can we begin to know the underlying cause of the ballooning healthcare cost.

There are 691,000 practicing physicians in the U.S. Let us assume that the average salary is $250,000 dollars. This is probably a high average number.

The healthcare system costs America approximately $2.5 trillion dollars ($2,500,000,000,000) a year.

691,000 physicians averaging $250,000 equals $172,750,000,000 ($172 billion 750 million dollars).

$172,750,000,000 billion divided by $2,500,000,000,000 trillion equal 6.91% of the healthcare dollars spent for physicians’ salaries.

Let us assume that each practicing physician’s overhead is 50%. This is also a high average. Therefore, physicians’ overhead and salaries are 13.8% of the total healthcare dollars spent.

There real issue in the raising cost of healthcare is where is the 86.2% of the U.S. healthcare costs going?

Mr. Lehrer ignores this issue.

The money is wasted on administrative bureaucracy, healthcare insurance executives’ salaries, hospital administrator salaries and an exorbitantly complex and expensive pharmaceutical bureaucracy.

Over 20 WellPoint executives make more than 10 million dollars a year with these numbers being stratified upward to over 25 million dollars a year plus bonus and stock options.

Some healthcare insurance executives receive over a billion dollars a year in bonuses and stock options.

Many levels of hospital administrative executive make over one million dollars a year with chief executives making over $15 million dollars a year.

I have been told “it is hard to get good help.”

With these sobering numbers on board the critical question is how much is a physician worth that has the education and ability to save lives?

This is the main reason Mr. Lehrer’s article in the Dallas Morning News is worse that Yellow Journalism.

The editors of the Dallas Morning News should be embarrassed by their publication of this article.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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Here Comes The Defective Judge (CMS)!

July 29, 2012

inDefective scientific studies, Medicine: Healthcare System

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Stanley Feld M.D., FACP, MACE

President Obama’s goal is to have the government be the single party payer for the entire healthcare system.

There is no doubt in my mind that the government as the single party payer will not work for patients or physicians.

President Obama cannot control CMS’s misuse of it assignments because bureaucratic complexity. One area of abuse and misuse of the department’s power is its attempt to eliminate fraud and abuse in Medicare and Medicaid.

There is no question that some healthcare providers abuse the Medicare and Medicaid payment system.

No one ever asks the critical question. Should the payment system used in Medicare and Medicaid be changed to prevent fraud and abuse?

Never the less President Obama is expanding the old punitive system. He thinks he is going to stop abuse with his expansion.

“ Stepping up their game against health care fraud, the Obama administration and major insurers announced Thursday they will share raw data to try to shut off billions of dollars in questionable payments.”

I don’t know how many times I have shown that claims data to determine quality of care or fraud and abuse is defective.

"Fraud is estimated by the administration to cost Medicare about $60 billion a year, and the Obama administration has beefed up the government's efforts to stop it, bringing in record settlements with drug companies for marketing violations as well as using new powers in the health care law to pursue low-level fraudsters with greater zeal."

This is a small amount compared to the $2.5 trillion dollar healthcare system cost when one considers the government’s investigative costs and the hardship these errors impose on many innocent physicians and patients investigated.

The hardships are enough to destroy physicians’ trust in the government and their desire to deal with the government.

It also serves to destroy the physician patient relationship.

Physician patient relationships are essential to the therapeutic success of a treatment regime.

Physicians have complained about this bureaucratic abuse to their congressmen. Congress has looked into this abuse. CMS’s approach has been to criminalize physicians using questionable data and decisions by unqualified judges.

Chairman Charlie Gonzalez of the House Small Business Committee outlines the problems brought to his attention several years ago. His hearings did not receive much attention.

Opening statement by Chairman Charlie Gonzalez

http://www.youtube.com/watch?v=0SmKmLMPu-s&feature=relmfu

Dr. Karen Smith a former President of the North Carolina chapter the American Association of Family Practitioners describes her encounter with CMS’s subcontractor for investigating fraud and abuse. CMS’s assignment is to discover Medicare and Medicaid underpayment or overpayment as well as fraud and abuse.

http://www.youtube.com/watch?v=3v4Sq7oDCgo&feature=player_embedded

I believe it is important for anyone who is interested in what is happening to the healthcare system to view the several You Tubes I am including in this blog.

Dr. Michael Schweitz, Vice President of The Coalition of State Rheumatology Organizations in West Palm Beach, FL discusses the defects in the RAC system and the need to change.

http://www.youtube.com/watch?v=E5K8iPqsmjY&feature=relmfu

Dr. Schweitz states that administrative costs in dealing with the government is overwhelming to physician practices. The stress imposed on physicians detracts from their ability to deliver quality medical care to their patients.

Most important is the government’s attitude toward the physicians and their practices. The physicians are guilty until they prove themselves innocent. Government’s subcontractors use claims data to prove the physicians guilt

Another problem is the more the outsourced company collects from physicians, the larger the commission it collects from CMS.

Mr. Timothy B. Hill is Chief Financial Officer, Director of the Office of Financial Management, Centers for Medicare & Medicaid Services. He answers questions from Chairman Charlie Gonzalez

http://www.youtube.com/watch?v=FBpXubSY8O8&feature=relmfu

The questions continue to Mr. Hill. He says CMS recognizes its abuse of physicians. He hopes to improve.

Since Obamacare has expanded physicians’ complaints have increased.

http://www.youtube.com/watch?NR=1&feature=endscreen&v=uRX1M31T8LA

Can anyone believe this testimony given by Mr. Hill? I hope his message is not believed by congress. Mr. Hill does not document his department policy changes

“ This week White House officials said a "trusted third party" would comb through data from Medicare, Medicaid and private health plans and turn questionable billing over to insurers or government investigators. That third party organization has yet to be selected.”

With the impending a thirty percent reduction in Medicare payments on January 1, 2013 physicians will not be able to afford care for Medicare and Medicaid patients.

Mr. Joseph A. Schraad, MHA Chief Executive Officer Oklahoma Allergy and Asthma Clinic, in Oklahoma City, describes the challenges that the practice he manages face. Less and less providers are going to accept Medicare.

http://www.youtube.com/watch?v=cINHOZmo_wA&feature=relmfu

Dr. Forrest in his direct care payment model for patients describes the formula he uses to avoid the government’s interference with his practice of medicine. He talk is riveting.

http://www.youtube.com/watch?v=dUX4P7XfY8o

Other formulas can be used. The You Tubes presented here demonstrate that the Judge (CMS) is using the wrong formula. The CMS cannot control their outsourced venders who have inappropriate incentives.

The are driving physician away from accepting Medicare and Medicaid payments. In the process patients lose

The way to solve fraud and abuse is to have patients police the healthcare system. Patients can uncover fraud and abuse if they own their healthcare dollar and have financial incentives to save unspent money in a retirement fund.

Education and financial incentives will make consumers productive consumers.

The way to approach physicians is not to assume they are criminals and subject them to the stress and expense to defend them in a defective evaluation system.

Physicians must be educated on how to improve coding efficiency and the government’s system of measurement must be made more accurate and less complex. ICD 10 is a big mistake. It makes coding complicated.

The best formula, in my opinion, is to empower and educate patients.

Government and employers must provide patients with financial incentives to become educated buyers of medical care services. Patients must be given the opportunity to own their healthcare dollars and be responsible for their own health and healthcare.

My ideal medical savings account provides patients with that opportunity.

Physicians collect only 10% of the healthcare dollars spent.

The real question is who collects the remainder of the 2.5 trillion dollars spent?

America should not depend on increased bureaucracy and bureaucratic staff to administer medical care with increased and confusing rules.

Everyone knows this will only result in increased inefficiency and higher costs.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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Safety Net Hospitals Are Methodically Being Destroyed.

July 25, 2012

inMedicaid, Medicare, Medicine: Healthcare System

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Stanley Feld M.D., FACP,MACE

Safety net hospitals have played a vital role in the care of America’s indigent population for over one hundred years.

Over the past few years’ safety net hospitals throughout the country have gone out of business. Fifteen percent of the hospitals in the United States are publically owned safety net hospitals. These are city or county hospitals.

“The urban public hospitals are often associated with medical schools.^[7] The largest public hospital system in America is the New York City Health and Hospitals Corporation, which is associated with the New York University School of Medicine.”

These hospitals receive funding from local, state, and federal government. They are also allowed to charge Medicaid, Medicare, and private insurers for the care of patients that have these forms of insurance.

Poor uninsured patients receive their care free from safety net hospitals.

Public hospitals, especially in urban areas, have a high concentration of uncompensated care. Their association with medical schools as teaching hospitals is an additional funding source provided by the federal government.

“The federal government provides funding to hospitals that treat indigent patients through the Disproportionate Share Hospital (DSH) payments.”

About 2,000 hospitals receive this funding. The problem is these DSH payments are highly concentrated.

Sixty-three percent of total DSH payments go to large teaching hospitals in urban areas.

DSH funding method is political and bureaucratic. Payments are manipulated. Medicaid eligibility and coverage vary widely across states and change the distribution of funds.

DSH payments have been distributed unevenly across geographic areas and away from rural safety net hospitals.

The uneven distribution is toward large urban safety net hospitals in the Middle Atlantic, South Atlantic, and Pacific regions. Those hospitals account for 60 percent of all DSH payments but only account for 46 percent of Medicare discharges.^[2]

The result is public safety net hospitals in America are closing at a much faster rate than hospitals overall.

“ The number of public hospitals in major suburbs declined 27% (134 to 98) from 1996 to 2002.”

As the number of uninsured and indigent patients has increased, their expenses in providing uncompensated care have drained the suburban and rural public hospitals funds.

Treating patients without receiving compensation has also drained urban non teaching hospitals.

Public and non-profit rural hospitals form a large part of the health care safety net for the indigent and uninsured in the U.S.^[9]

Several large safety net hospitals have gone into bankruptcy because cities and states could not afford to fund them.

Two prominent examples are Martin Luther King in Los Angeles and Grady Memorial in Atlanta. Grady Memorial in Atlanta has gone into bankruptcy twice only to be rescued the citizens of the city of Atlanta.

Non-profit community hospitals can collect federal funds if they treated a certain percentage of indigent and Medicaid patients.

In order to reach that percentage the federal government has allowed community hospitals to eliminate certain beds from its total hospital bed count. The hospitals can eliminate outpatient observation beds, skilled nursing swing beds and ancillary labor/delivery services beds from its total bed count.

It inflates the percentage of charity beds a non-profit hospital counts toward government subsidy. This is a totally political maneuver.

In effect it decreases federal funding to city and county safety net hospitals.

In October 2012, Obamacare is starting to adjust federal hospital payments based on quality of care. One of the primary metrics will be patient experience rating that covers everything from the communication skills of doctors and nurses to their promptness in responding to complaints about pain.

A new study in the Archives of Internal Medicine finds that this change may add to the financial troubles of safety net hospitals, which primarily serve poor patients. The safety net hospitals tend to get poorer marks from patients than do other hospitals.

“On average, they drew top ratings from 63.9 percent of patients while the hospitals that treated the fewest poor people got top ratings from 69.5 percent of patients.”

The gap has gotten widen over time. It means that the non-profit hospital will get a larger share of the federal money than the safety net hospitals.

I have written several articles on how the federal government has been destroying these safety net hospitals throughout the country.

In the first year of the Hospital Value-Based Purchasing program that starts this October, patient experience scores will determine 30 percent of the bonus.

The rest of the bonus will be determined by how hospitals adhere to basic guidelines for clinically recommended care.

The hospitals that perform best will receive a higher bonus. Those that lag in their scores will end up with less.

Many safety net hospitals do not have the funds to buy adequate information technology to record the required treatment protocols.

It means that non-profit hospitals will receive additional bonus money and safety net hospitals will be penalized.

To add insult to injury the vital safety net hospitals’ decrease in federal funds could push them “closer to bankruptcy.”

President Obama’s program will make it even worse for safety net hospitals in October 2013.

Obamacare will start reducing special payments to hospitals that treat disproportionately large numbers of indigent patients. Safety net hospitals are the hospital treating a disproportionately larger number of indigent patients.

Without this funding the safety net hospitals cannot improve quality or provide services to indigent people.

The questions to ask are,

Are the measurement used to determine quality care wrong?
Is President Obama trying to destroy the safety net hospital system on purpose?
Does he not realize that many indigent Americans depend on safety net hospitals?

What is going on here?

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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Another Big Mistake!

July 18, 2012

inMedicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

On July 1, with great fanfare, CMS announced that 89 organizations have been chosen to serve the healthcare needs of some 1.2 million Medicare beneficiaries in CMS’ Accountable Care Organizations (ACO) program.

Many of the premier integrated health systems, such as Mayo Clinic, Cleveland Clinic, Geisinger Health System, and Intermountain Healthcare had rejected an invitation to participate in the program in June 2011.

Among the reasons for rejecting the government’s offer to be a participant were the complex, contradictory and burdensome rules, the risk in shared savings, and the need for participating patients to be included in oversight boards.

Leaders of all four organizations praised the ACO concept but criticized the proposed implementation. Geisenger Health System said “

“It seems to be very prescriptive and restrictive with a fair amount of administrative and regulatory oversight."

The recent CMS press release makes it sound as if the ACO program is off to a good start.

Totally false!

There are 35 million seniors and disabled persons presently on Medicare. The program will include 1.2 million Medicare patients.

1.2 million Medicare enrollees represent less than 3.4% of patients on Medicare.
The number of organizations enrolled does not represent validation of the acceptance of the ACO process by the medical community.
It does not represent validation of the contention that routing Medicare patients through ACO’s will save money.

The growth in the cost of care’s baseline, on which an ACO organization will be measured, is not defined. The participating ACO organization cannot possibly know what the downside risk is.

It looks like CMS waived the downside risk temporarily for 84 of the 89 ACO’s who signed up. The waiver will not last forever. When it ends it will be too late for these ACO’s to get out.

CMS delayed the original start date from January 1,2012 to July 1,2012. This was an ominous sign. As far as I can tell no one has any idea how many of the groups signed up are integrated care groups.

SUMMARIES OF ACOS SELECTED FOR JULY 1, 2012 START DATE[1]

http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4405&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

I have written several articles explaining why I believe ACO’s will be a gigantic waste of government money, which will add to America’s deficit.

“The more I study ACOs the worse they look. Dr. Berwick’s goal is redistribution of wealth. This is exactly what ACOs are going to do. Patients, taxpayers and physicians are going to get the short end of the distribution.

Hospital systems are spending a ton of money trying to form ACOs. They are going to lose big. I have concentrated on the obvious defects and difficulties in forming ACOs in the past. Here are some more traps.”

"Dr. Don Berwick and his associates have a naïve view of the ability of organizations to form and execute Accountable Care Organizations (ACOs). ACOs fit well into President Obama’s worldview of government controlling our healthcare system."

There are three major problems:

The government is broke. It does not have the money to pay for a government takeover of the healthcare system.
New systems need participant cooperation to succeed.
Creating a fully integrated healthcare system is difficult to nearly impossible unless the system has salaried physicians and a fully transparent hospital/physician provider organization. This will not happen soon in the current hospital and physician cultural milieu.

“President Obama and Dr. Don Berwick have overestimated the abilities of the healthcare system to respond to their hubristic assumptions.”

“The ACO program is based on the hubristic assumption that the federal government can design the best organizational structure for the delivery of care, foster its development, and control its operation for the entire country."

Physicians and hospital system will not cooperate because:

Physicians and hospitals have little experience or control in managing risk.
Physicians and hospital systems experience with HMO’s in the 1980’s proved their inability to manage risk.
It was a painful financial experience for both.
Most physicians and hospital systems are not very interested in assuming this risk again.

The risk of ACOs has been sugar coated by the administration.

Patients are the only stakeholders who can control their healthcare risk. All health policy wonks ignore the role of the patients in controlling and managing their healthcare risk.

Dr. Berwick thinks hospitals and physicians will be motivated to control patients’ healthcare risk with ACOs.

He is wrong. I predicted participation would be minimal.

Physicians take on enormous risk taking care of patients presently. The risk increases when patients do not follow physicians’ treatment recommendations.

Physicians are in no mood to take on financial responsibility and malpractice risk for actions that might fail because of patients’ non-adherence. Patients have to be motivated with health and financial incentives to comply.

Those physicians and hospital systems participating in the ACO program will lose financially and professionally.

There are several other key points for the lack of success of the ACO program

" Obamacare uses Medicare reimbursement as an incentive to create accountable care organizations (ACOs), which the federal government has decided are the way to deliver quality care at lower cost.
Proposed regulations by the Centers for Medicare and Medicaid Services (CMS) are largely confusing, impenetrable, and inconsistent.
They give CMS detailed control over ACOs and the providers who participate in them, including censorship of ACO communications with Medicare beneficiaries.
Medicare beneficiaries are assigned to ACOs without their knowledge or consent.
Membership, in reality, is a retrospective bookkeeping entry relevant only to financial dealings between CMS and the ACO. ACOs may even have to pay money back to Medicare if they do not meet CMS goals for savings.
The incentives offered to ACOs are diffuse and speculative, entailing intrusive regulation of ACOs and providers.
ACOs as defined by Obamacare are fatally flawed and cannot be fixed by merely changing the proposed regulations."

This is neither a Democrat nor Republican issue. It is an issue of developing a healthcare system that will work. The cost of developing this government controlled healthcare system that is doomed to fail is enormous.

The Mayo Clinic, Cleveland Clinic, Kiesinger Health System, and Intermountain Healthcare are probably the most integrated healthcare systems existing in America. They visualized the lack of potential for success in ACO’s present structure.

Thirty-six organizations signed up for the Pioneer Demonstrations ACO 6 months ago. The list and details can be found on the CMS fact sheet. The details of the deal they made are not easily available.

innovations.cms.gov/Files/fact…/Pioneer–ACO-General-Fact-Sheet.pd

It is worth studying all of the organizations that were selected for the Pioneer ACO program. These organization must believe they are in a no lose situations. They will find out that they will lose and it will be too late to get out.

All of the organizations represent a very small percentage of practicing physicians. These physicians take care of a very small portion of Medicare patients.

It will take several years and much money to decide the ACO’s will fail. The only healthcare system that will align all the stakeholders’ incentives is my Ideal Medical Savings Account.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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John Lynn • July 21, 2012

I love the commentary and the strong view on ACOs. It is a terrible sign that the major integrated health systems aren’t participating in the government ACO.
I love your points about the risks that doctors currently take are an issue and get worse with an ACO. I wrote about this before: http://www.emrandhipaa.com/emr-and-hipaa/2012/02/29/aco-model-risks-and-rewards/ I’m from Vegas and participating in an ACO is very much like gambling.
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With Obamacare Patients Lose

July 15, 2012

inMedicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

President Obama, in his attempt to create a healthcare system that is more efficient, affordable and democratic does not attack the basic dysfunctions in the healthcare system.

Obamacare does nothing to disintermediate the healthcare insurance industry.

It does not provide incentives for consumers to be responsible for their health or their healthcare dollar.

It creates another entitlement and increased consumer dependency on government rather than consumer independence.

It does nothing to alleviate the practice of defensive medicine and the waste of $750 billion dollars for unnecessary tests that would be eliminated if effective Tort Reform were enacted.

President Obama and his advisors believe that defensive medicine accounts for only 2-3 billion dollars a year.

They conclude the cost is insignificant. They are ignoring reality proven by well-done studies. Their premise is incorrect. Ignoring the facts will continue the dysfunction in the healthcare system.

I have stated repeatedly that I believe President Obama’s goal is complete government control of the healthcare system.

The rules in Obamacare will destroy the patient physician relationship and private healthcare.

The only system left will be the government’s Public Option through Health Insurance Exchanges. Everyone will be on Medicare or Medicaid.

Both Medicare and Medicaid are presently unsustainable. Expanding both will accelerate the demise of both Medicare and Medicaid.

The resulting socialized Medicine will be an unsustainable disaster as it has become in England and Canada.

The public knows Obamacare will fail. They also know we need to do something. The public needs to hear about a viable alternative.

With Obamacare premiums will increase along with taxes. Access to care and rationing of treatment will occur.

The path America is on is “The Road To Serfdom” as described by Fredrick Hayak. Serfdom is occurring slowly but steadily. President Obama has told us in his own words how we will get there.

He sounds great because he is charming and seductive. His only problem is he is not truthful about his goal and its cost to society.

http://youtu.be/i2e-86eOIT0

Consumers will be the biggest losers.

The more than 250 million consumers who already have health insurance will see their healthcare insurance change, the cost increase, and the quality of care diminish.

How will Americans feel when they hear about a brand new cure only to find out that their government’s controlled insurance won’t cover it? The decisions to cover care will be made by a non-elected committee that sends its recommendation to another not elected committee who then sends it to a third committee to decide on whether the treatment is affordable or valid for the age of the patient.

“Patients will have to get used to less access to real health care solutions, fewer approvals for the very latest, personalized, genetic-based cancer treatment or surgical technology that could save your life.”

Who loses? The consumer.

The Doctor Patient Medical Association released survey of doctors showing that 90% believe that Obamacare is on the wrong track.

The same survey revealed that 83% of practicing physicians are contemplating quitting the practice of medicine.

The physicians remaining in practice will see more patients per hour and have care of their patients dictated to them by the government bureaucrats. Obamacare will turn personalized patient care into commodity care.

There will be no patient physician relationship. There will be rationing of care and decreased access to care. Patient’s will not have freedom of choice for care or treatment.

A recent article in Britain’s Daily Mail described the use of the “Liverpool Pathway. A British Professor claims the NHS kills off 130,000 elderly patients every year using the Liverpool Pathway.

The Liverpool Pathway is a set of rules that decide who should receive treatment and who should not receive treatment.

“Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an ‘assisted death pathway rather than a care pathway.”

Under Obamacare physicians will bear the brunt of explaining how come ever rising premiums are buying you fewer and fewer benefits.

Consumers who can afford to pay physicians directly will not receive a tax break unless their medical care expenses are more than 10% of their gross income.

The popular Health Savings Accounts will perish because of the barriers against them as written into the healthcare law.

The Healthcare System’s savior “My Ideal Medical Savings Accounts” will vanish from consideration.

Obamacare also restricts physicians’ clinical judgment. Sometimes physicians will sense a patient is really sick with a serious disease. An example is a disease called a fever of unknown origin. Many tests would have to be performed to make the diagnosis. The sooner the diagnosis is made the better the chance for patients to survive.

Physicians might fear the Independent Medicare Advisory Board would deny the workup and penalize the physician. It could be that the Independent Medicare Advisory Board members and the other committees did not factor in the difficulties in the diagnosis.

In time the diagnosis would become obvious but it might be too late to save the patients life.

We have already seen healthcare premiums soar under Obamacare. I have shown that Medicare premiums are schedule to escalate in 2014. Medicare and Medicaid is healthcare insurance.

Healthcare insurance will be less affordable not more affordable even though government subsides will be greater. The budget deficit will grow increase.

Access to care will decrease because of the increased number of patients. Physicians will have less time to spend with patients. A growing number of patients will have increased difficulty finding a physician.

There is a current physician shortage. The physician shortage will become compounded when some physicians stop practicing medicine. Other physicians will either restrict the healthcare insurance plans they accept or stop accepting healthcare insurance completely.

The delivery of healthcare is getting worse and more expensive not better and less expensive.

Obamacare is creating an escalating mess.

Patients are going to be the biggest losers on every level of interaction with the President Obama’s Healthcare Reform Act.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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migraine treatment • July 18, 2012

Thanks for all your efforts explaining all that is soooo wrong with Obama and his ilk. I find you informative and entertaining please keep up the great work.
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Mr. Romney: Wake Up!!

July 11, 2012

inMedicine: Healthcare System, Stakeholder Mistrust

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Stanley Feld M.D.FACP,MACE

It will be up to Mitt Romney and the Republicans to define the connection of President Obama’s policies to:

The faltering economy
The disastrous healthcare bill
The lack of job growth
The growth of entitlements
The tremendous increase on the deficit
The slow but steady imfringement of the federal government on Americans’ freedoms

“I have a feeling President Obama will outsmart the Republicans and Mitt Romney with additional trick plays.”

President Obama is using trick plays to fake out Mitt Romney and the Republicans. He is keeping them on the defensive.

Everyday he changes the subject and grabs the traditional media’s headlines.

President Obama is avoiding debate on all these interconnected issues.
President Obama’s strategy is to blame the Republicans for all America’s ills.
He is issuing executive orders that have little impact on the basic policy defects.
He is ignoring the budget deficits created by excessive bureaucracy.
The power of the pulpit is in his favor.
He has the momentum because he is controlling the conversation in a relaxed and natural way.

I believe Mitt Romney needs more media training. Americans love charisma.

Mitt Romney needs to be taught how to be charismatic. Mitt Romney must articulate his vision with vigor. He must be less wooden.

Otherwise Mitt Romney will lose the election even thought President Obama’s vision of America is not the vision of most Americans.

He needs advisors who will get him on the offensive.
He has to explain why President Obama’s Healthcare Reform Act and economic policies have created a multi-trillion dollar increase in America’s deficit without improvement in America’s economy.
He needs to explain how President Obama is devaluing the dollar.
He needs to explain how President Obama stimulus packages are decreasing Americans’ purchasing power.
Mitt Romney needs to explain how President Obama’s ideology is counter to most Americans’ vision of America.
Mitt Romney has to point out on President Obama’s defects in foreign policy.
Mitt Romney should not be giving President Obama a pass on issue especially Obamacare.

Mitt Romney needs to tell us his plans. Simply saying he knows how to create jobs is meaningless. Americans have seen how large corporations have taken advantage of a free market economy.

Mitt Romney has to tell American’s his plans to fix healthcare, the economy, and unemployment. Simply saying he knows how to create jobs is meaningless and hollow.

Diehard Democrats are going to vote for President Obama without thinking about his disastrous policies of spending and taxing that are driving America over a financial cliff.

Remember Thelma and Louise.

Republicans are going to vote Republican.

Mitt Romney must ignite the imagination of Independents and Libertarians with the sense that he has a plan to fix America.

He must generate a sense of real hope and neutralize President Obama’s false hope.

A thoughtful physician wrote this letter to Mitt Romney. This reader sent a copy to me. I asked him if I could publish it. He asked me to reveal that he quotes an editorial written in the Wall Street Journal heavily. The quotes in Dr. Nunn’s letter are from the editorial.

The first sentence in the WSJ editorial says it all.

“If Mitt Romney loses his run for the White House, a turning point will have been his decision Monday to absolve President Obama of raising taxes on the middle class. He is managing to turn the only possible silver lining in Chief Justice John Roberts's ObamaCare salvage operation—that the mandate to buy insurance or pay a penalty is really a tax—into a second political defeat.”

Dear Mitt

You're losing the battle for POTUS over Obama, and need to take immediate action. In Texas, we ask, are you going to fish, or cut bait? So far, you're cutting bait. Time to step up to the plate and do the right thing.

For the following, I lean heavily on the July 5, 2012 WSJ Review and Outlook article.
http://online.wsj.com/article/SB10001424052702304141204577506652734793044.html?KEYWORDS=romney%27s+tax+confusion

In my opinion, here's what you need to do. You will have my vote. If you want my financial support, you'll need to show solid prompt evidence that you 'get it' and decide to fight for the win.

"The health-care tax debate [is not] closed!"

Make sure you and your senior advisors are on the same page.

Eric Fehrnstrom is out of touch. Replace him.

Reverse your "tax absolution gift to [Mr.] Obama."

Quit "muddying] the tax issue" over the mandate tax.

"Admit your [Romney care Massachusetts] mistake" about the individual mandate.

Call the mandate "a tax" and "work to repeal it."

Acknowledge that Obama's plans will tax "the middle class," not just the wealthy.

Reply to Democrats who will point out your Massachusetts record, that "that was before [SCOTUS] had spoken," and adopt the "policy to repeal the tax" and "the rest of Obamacare."

You are jeopardizing your chances of winning the election by "not abandoning [your] faulty [Massachusetts] health-care legacy."

Quit "squandering an historic opportunity" to take advantage of the weakening "economic recovery" which is hurting Obama.

Articulate, "why the [POTUS'] policies aren't working and how [you]… will do better."

Counter Obama's characterization of you as "out-of-touch," wealthy, and "with foreign bank accounts." It was OK for JFK, and it's OK for you. Counter it!

Fight the Bain Capital assaults, and "job outsourcer" issues. Do not "let [it] go unanswered."

You can't live by your history alone.

People are 'results-oriented.' Let us "know how [you] are going to improve [our] future." "Offer… a larger economic narrative and vision than [you have] so far provided."

"Point…out [your] differences… on higher taxes, government-run health care, punitive regulation[s], and…[government] waste," driven by political concerns, and entitlement programs.

If you're "the best man to make the case against [Obama], whom [Republicans really] want to defeat, [you're so far,] letting them down."

http://online.wsj.com/article/SB10001424052702304141204577506652734793044.html?KEYWORDS=romney%27s+tax+confusion

Now, please go and do the right thing, or we'll see our nation go further down the tubes under a 2nd Obama administration!

Sincerely,

Roger D. Nunn, MD, FACS

Dr. Nunn’s letter represents the thinking of many Americans. Mitt Romney has to go on the offensive with effective advice and media delivery.

President Obama has seduced a lot of people and will continue to be seductive. He seduced me once with his half-truths. These half-truths had generated hope for America that turned out to be false hope.

Some people are so disenchanted that the call his half-truths outright lies.

http://youtu.be/56c1fSdTAWI

Perhaps prevarication is a better term than half-truths.

A prevarication is a statement that deviates from or perverts the truth.

Mr. Romney, don’t let President Obama get away with these prevarications.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Carl • July 11, 2012

What is the difference between ObamaCare and RomneyCare? It’s either Gary Johnson or socialized medicine.
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Obamacare Tax Increases That Have Been Forgotten

July 8, 2012

inDisinformation and the healthcare system, Medicine: Healthcare System, Politicians,Healthcare and Vested Interests

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Stanley Feld M.D.,FACP,MACE

Americans have forgotten the increase in taxes written into President Obama’s Healthcare Reform Act. There are 20 hidden taxes in the law that effect citizens making 250,000 dollars a year or less. These taxes contradicts President Obama’s promise.

Grover Norquist wrote an excellent summary of those new taxes for the public to review. President Obama’s hypocrisy toward the American people is obvious.

These taxes and Mr. Norquist’s summary is ignored by the traditional media.

Since the recent Supreme Court decision has managed to keep Obamacare alive, it is vital that voters in all income brackets understand the new taxes imbedded in the law.

President Obama was not telling the truth when he said citizens earning under $250,000 would not pay one single dime more in taxes.

http://youtu.be/56c1fSdTAWI

Grover Norquist is president of Americans for Tax Reform, a coalition of taxpayer groups, individuals, and businesses opposed to higher taxes at the federal, state, and local levels. The coalition organizes the Taxpayer Protection Pledge, which asks all candidates for federal and state office to commit themselves in writing to oppose all tax increases.

In my last blog “ The Supreme Court And Obamacare” I said Obamacare is the largest tax increase in American history. As things go sour for Obamacare the government is going to have to raise taxes even further.

Taxpayers earning under $250,000 will experience the burden of the $500 billion dollar increase in taxes.

“Obamacare contains 20 new or higher taxes on American families and small businesses.

Arranged by their respective effective dates, below is the total list of all $500 billion-plus in tax hikes (over the next ten years) in Obamacare, where to find them in the bill, and how much your taxes are scheduled to go up as of today:

Taxes that took effect in 2010:

1. Excise Tax on Charitable Hospitals (Min$/immediate): $50,000 per hospital if they fail to meet new "community health assessment needs," "financial assistance," and "billing and collection" rules set by HHS. Bill: PPACA; Page: 1,961-1,971.

2. Codification of the “economic substance doctrine” (Tax hike of $4.5 billion). This provision allows the IRS to disallow completely-legal tax deductions and other legal tax-minimizing plans just because the IRS deems that the action lacks “substance” and is merely intended to reduce taxes owed. Bill: Reconciliation Act; Page: 108-113.

3. “Black liquor” tax hike (Tax hike of $23.6 billion). This is a tax increase on a type of bio-fuel. Bill: Reconciliation Act; Page: 105.

4. Tax on Innovator Drug Companies ($22.2 bil/Jan 2010): $2.3 billion annual tax on the industry imposed relative to share of sales made that year. Bill: PPACA; Page: 1,971-1,980.

5. Blue Cross/Blue Shield Tax Hike ($0.4 bil/Jan 2010): The special tax deduction in current law for Blue Cross/Blue Shield companies would only be allowed if 85 percent or more of premium revenues are spent on clinical services. Bill: PPACA; Page: 2,004.

6. Tax on Indoor Tanning Services ($2.7 billion/July 1, 2010): New 10 percent excise tax on Americans using indoor tanning salons. Bill: PPACA; Page: 2,397-2,399.

Taxes that took effect in 2011:

7. Medicine Cabinet Tax ($5 bil/Jan 2011): Americans no longer able to use health savings account (HSA), flexible spending account (FSA), or health reimbursement (HRA) pre-tax dollars to purchase non-prescription, over-the-counter medicines (except insulin). Bill: PPACA; Page: 1,957-1,959.

8. HSA Withdrawal Tax Hike ($1.4 bil/Jan 2011): Increases additional tax on non-medical early withdrawals from an HSA from 10 to 20 percent, disadvantaging them relative to IRAs and other tax-advantaged accounts, which remain at 10 percent. Bill: PPACA; Page: 1,959.

Taxes that took effect in 2012:

9. Employer Reporting of Insurance on W-2 (Min$/Jan 2012): Preamble to taxing health benefits on individual tax returns. Bill: PPACA; Page: 1,957.

Taxes that take effect in 2013:

10. Surtax on Investment Income ($123 billion/Jan. 2013): Creation of a new, 3.8 percent surtax on investment income earned in households making at least $250,000 ($200,000 single). This would result in the following top tax rates on investment income: Bill: Reconciliation Act; Page: 87-93.

	Capital Gains	Dividends	Other*
2012	15%	15%	35%
2013+	23.8%	43.4%	43.4%

*Other unearned income includes (for surtax purposes) gross income from interest, annuities, royalties, net rents, and passive income in partnerships and Subchapter-S corporations. It does not include municipal bond interest or life insurance proceeds, since those do not add to gross income. It does not include active trade or business income, fair market value sales of ownership in pass-through entities, or distributions from retirement plans. The 3.8% surtax does not apply to non-resident aliens.

11. Hike in Medicare Payroll Tax ($86.8 bil/Jan 2013): Current law and changes:

	First $200,000 ($250,000 Married) Employer/Employee	All Remaining Wages Employer/Employee
Current Law	1.45%/1.45% 2.9% self-employed	1.45%/1.45% 2.9% self-employed
Obamacare Tax Hike	1.45%/1.45% 2.9% self-employed	1.45%/2.35% 3.8% self-employed

Bill: PPACA, Reconciliation Act; Page: 2000-2003; 87-93

12. Tax on Medical Device Manufacturers ($20 bil/Jan 2013): Medical device manufacturers employ 360,000 people in 6000 plants across the country. This law imposes a new 2.3% excise tax. Exempts items retailing for <$100. Bill: PPACA; Page: 1,980-1,986

13. Raise "Haircut" for Medical Itemized Deduction from 7.5% to 10% of AGI($15.2 bil/Jan 2013): Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5 percent of adjusted gross income (AGI). The new provision imposes a threshold of 10 percent of AGI. Waived for 65+ taxpayers in 2013-2016 only. Bill: PPACA; Page: 1,994-1,995

14. Flexible Spending Account Cap – aka “Special Needs Kids Tax” ($13 bil/Jan 2013): Imposes cap on FSAs of $2500 (now unlimited). Indexed to inflation after 2013. There is one group of FSA owners for whom this new cap will be particularly cruel and onerous: parents of special needs children. There are thousands of families with special needs children in the United States, and many of them use FSAs to pay for special needs education. Tuition rates at one leading school that teaches special needs children in Washington, D.C. (National Child Research Center) can easily exceed $14,000 per year. Under tax rules, FSA dollars can be used to pay for this type of special needs education. Bill: PPACA; Page: 2,388-2,389

15. Elimination of tax deduction for employer-provided retirement Rx drug coverage in coordination with Medicare Part D ($4.5 bil/Jan 2013) Bill: PPACA; Page: 1,994

16. $500,000 Annual Executive Compensation Limit for Health Insurance Executives ($0.6 bil/Jan 2013). Bill: PPACA; Page: 1,995-2,000

Taxes that take effect in 2014:

17. Individual Mandate Excise Tax (Jan 2014): Starting in 2014, anyone not buying “qualifying” health insurance must pay an income surtax according to the higher of the following

	1 Adult	2 Adults	3+ Adults
2014	1% AGI/$95	1% AGI/$190	1% AGI/$285
2015	2% AGI/$325	2% AGI/$650	2% AGI/$975
2016 +	2.5% AGI/$695	2.5% AGI/$1390	2.5% AGI/$2085

Exemptions for religious objectors, undocumented immigrants, prisoners, those earning less than the poverty line, members of Indian tribes, and hardship cases (determined by HHS).Bill: PPACA; Page: 317-337

18. Employer Mandate Tax (Jan 2014): If an employer does not offer health coverage, and at least one employee qualifies for a health tax credit, the employer must pay an additional non-deductible tax of $2000 for all full-time employees. Applies to all employers with 50 or more employees. If any employee actually receives coverage through the exchange, the penalty on the employer for that employee rises to $3000. If the employer requires a waiting period to enroll in coverage of 30-60 days, there is a $400 tax per employee ($600 if the period is 60 days or longer).Bill: PPACA; Page: 345-346

Combined score of individual and employer mandate tax penalty: $65 billion/10 years

19. Tax on Health Insurers ($60.1 bil/Jan 2014): Annual tax on the industry imposed relative to health insurance premiums collected that year. Phases in gradually until 2018. Fully-imposed on firms with $50 million in profits. Bill: PPACA; Page: 1,986-1,993

Taxes that take effect in 2018:

20. Excise Tax on Comprehensive Health Insurance Plans ($32 bil/Jan 2018): Starting in 2018, new 40 percent excise tax on “Cadillac” health insurance plans ($10,200 single/$27,500 family). Higher threshold ($11,500 single/$29,450 family) for early retirees and high-risk professions. CPI +1 percentage point indexed. Bill: PPACA; Page: 1,941-1,956

Mr. Norquist left out the worse tax of all. This “tax” is under everyone’s radar. It has never been mentioned in the traditional mainstream media. It is the tax on Seniors who are on Medicare.

"The per person Medicare Insurance Premium will increase from the present
Monthly Fee of $96.40, rising to:

$104.20 in 2012

$120.20 in 2013

And

$247.00 in 2014."

All seniors are means tested. This means the greater your income from any source including work income, pension income, capital gains and interest or dividend income the higher the baseline premiums become.

This “tax” had been decided by a Democratic controlled congress that had not read the bill or understood all of its consequences.

These are provisions incorporated in the Obamacare legislation, purposely

delayed so as not to anger seniors during President Obama’s 2012 Re-Election Campaign.

Please send this blog to all the seniors you know and their children. It is important for them to know that President Obama is throwing seniors under the bus. Obamacare must be repealed.

Everyone must stay focused. President Obama is going to try to change the conversation.

Some of these taxes have already gone into effect. If the Republicans win the House and the Senate as well as the Presidency, Obamacare must be repealed.

Everyone interested in America’s economic future must tell a friend. President Obama has deceived Americans.

It is time for everyone to get angry and vote him out of office in November.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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Daniel Silver • July 11, 2012

The number 9 tax note that the insurance premiums paid by your employer will be reported on the W2 and then at some later date a tax will applied to that amount. This is the most dangerous precedent for all citizens in this country.
I do not think that the excise tax on indoor tanning salons is going to hurt many nor make a lot of revenue for our legislators to play with.
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The Supreme Court And Obamacare

July 2, 2012

inDisinformation and the healthcare system, Medicine: Healthcare System

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Stanley Feld M.D., FACP, MACE

On June 28, 2012 the Supreme Court ruled on the constitutionality of President Obama’s Healthcare Reform Act. Chief Justice Roberts read the majority opinion. He sided with the four liberal judges in ruling it constitutional.

The pundits on the left and the right have been speculating on the significance of the decision for the past five days. It can make anyone who is trying to understand the significance of the decision, as I have, dizzy.

The fact is Obamacare is a terrible law. It must be repealed. It is a super entitlement program that will bankrupt our nation.

Recently, the CBO said is would increase the budget deficit $1.76 trillion dollars over the next 10 years. President Obama has claimed Obamacare will decrease the deficit.

Obamacare is going to be difficult to execute because of programs such as Accountable Care Organizations. Deadlines have already been extended. This will result in increased cost and increased budget deficits.

States do not want to increase their spending, raise taxes, or go into further debt States are required to balance their budgets. Most will not cooperate with the expansion of Medicaid or the Heath Insurance Exchanges.

The role of the executive branch of the government has already been expanded on President Obama’s watch. Non-elected officials are making policy decisions without congressional approval.

The end result will be that the healthcare system will collapse. The federal government will then socialize medicine completely.

I believe this is President Obama’s goal. It is the reason he did not insist on the Public Option before passage of the bill.

President Obama has used many trick plays to achieve his goal. The last trick he played was to try to intimidate the Supreme Court.

http://youtu.be/yWZ9JVvUG0g

I was positive President Obama could not intimidate the Supreme Court justices. It is hard to know if President Obama’s intimidation tactic influenced Chief Justice Roberts’ decision.

Some believe Chief Justice John Roberts has handed a remarkable victory to American Independents, Libertarians, and Republicans by declaring Obamacare’s application of the commerce clause unconstitutional.

The effect would be to limit broad application of the commerce clause. In the past the federal government has used the commerce clause to justify its intrusion in Americans’ personal life and limit their freedom of choice.

Nancy Pelosi was grinning from ear to ear and made a couple of incomprehensible comments about President Obama, Harry Reid and her victory in the Supreme Courts decision. She even had a party before congressional members.

We can all remember Nancy Pelosi gloating and saying, "we cut half a trillion dollars from Medicare” to pay for ObamaCare.

She has been credited with being the mother of “double counting.” She also made this brilliant statement, "We have to pass the bill to find out what’s in it.”

Sixty percent of Americans do not like Obamacare. They want it repealed.

If the commerce clause was upheld the federal government could force Americans to buy and eat broccoli.

The error the Chief Justice made is that by declaring it a tax the government can tax people who choose not to eat broccoli.

“However, with Chief Justice Roberts almost surreptitiously joining with Justices Scalia, Thomas, Alito, and Kennedy in ruling that ObamaCare is barred by the federal Commerce Clause, a new era has begun in Commerce Clause jurisprudence.”

This is a big deal. It limits the federal government’s power over its citizens by resetting the rules for lower courts.

Long after many of us are gone, this 5-4 opinion finally setting limits on the reach of the Commerce Clause will continue to affect American lives and protect private citizens from Washington's intrusions.

In order to pass Obamacare with 60 votes needed in the Senate, President Obama threatened some Democratic senators into voting for his bill.

President Obama jammed an unpopular healthcare reform act through a barely willing Democratic dominated congress.

President Obama insisted on the mandate. He claimed it was constitutional according to the commerce clause.

President Obama did not want to impose a tax at a time the economy was so poor. A tax on families earning less than $250,000 a year would have been political suicide.

President Obama would not have gotten 60 Democratic votes in the Senate if he was imposing a tax on those corporations, organizations, and individual who chose not buy healthcare insurance.

The Healthcare Reform Act was passed without bipartisan support. Therefore, President Obama cannot claim that the bill was passed by a bipartisan congress.

“Chief Justice Roberts majority decision said the Federal Government does not have the power to order people to buy health insurance . . ..

His error was to give the President some help by calling it a tax.

The Federal Government does have the power to impose a tax on those without health insurance." (National Federation of Independent Business v. Sebelius, Slip op. at 3, 41-42, 44)”

President Obama has insisted it is not a tax but a mandate. Today he is insisting it a not a tax. It is a penalty for not buying insurance. The legal definitions of taxes, penalties and mandates are all different.

http://youtu.be/TdgPauuMmJI

No one can know if John Roberts was intimidated by President Obama’s admonition or if he thought he was acting to defend the constitution.

In effect, he and the liberal justices rewrote Obamacare as it was originally written.

Democratic congresspersons are starting to catch on. Many are declining to attend the Democratic Party’s convention.

“The ObamaCare tax does not apply to those who presently are untaxed, (50% of the public).

It will not apply to the more wealthy, who will be excused because they carry health insurance anyway.

Guess who absorbs the bullet? Families earning under $250,000 a year.

The President who promised no new taxes against the middle class conclusively has been "outed" by the Chief Justice as having imposed the biggest tax on middle-class Americans in a generation.

President Obama has “outed” his supporters with false hope throughout his presidency using trick plays. Seniors will be unhappy when they start realizing the impact of the $500 billion dollars removed from Medicare.

Employers will be hesitant to employ greater than 50 employees in order to avoid the tax. Unemployment will rise. Obamacare in offering money for unfunded liabilities as more people will need subsided insurance.

This represents the largest tax increase in United States history along with 20 other new taxes in Obamacare. These new taxes are going to affect everyone including taxpayers’ earning under $250,000 a year.

President Obama knew all along Obamacare’s mandate is not constitutional. He was trying to pull a trick play. He knew Americans would not buy an added tax.

He then faked out the Supreme Court when his lawyer asked if Obamacare would stand as constitutional if the mandate would be considered a tax.

“The idea that if Congress had mustered the courage to pass the mandate as the tax it is, it would have been well within its right to tax the people. But Congress didn't do that. They manipulated the language, and thereby the people, playing us for fools.”

The economy remains the major issue in the 2012 elections. President Obama will use every trick he can to divert America’s attention from the main issue. Obamacare is making the economy worse.

“The number-one national issue in the 2012 presidential election is economic, but as a cultural question, the scope, limits, and trustworthiness of government looms large and ominous to those who perpetrated the fraud of duplicity:

Disguising a wolfish tax in the sheep's clothing of moral imperative, just long enough to pass it. It's at least as unwise to scam voters, as it is not nice to fool Mother Nature.

Some believe that Chief Justice Roberts has given Republicans the ability to tie the healthcare issue back to the economy.

Chief Justice Roberts returned Obamacare front-and-center back into the November elections debate. Defining it for what it really is — a new, enormous federal tax on at least four million Americans (Slip op. at 37)

It will be up to Mitt Romney and the Republicans to define the connection of the two issues.

I have a feeling President Obama will outsmart the Republicans once again with additional trick plays.

John Roberts did not do Conservatives, Libertarians, the constitution, the economy or the American people a favor with his decision.

It is up to the people to speak at the voting booth on November 6^nd.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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The Government’s Role In A Free Society

June 27, 2012

inMedicaid, Medicare, Medicine: Healthcare System

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Stanley Feld M.D.,FACP,MACE

U.S. Congressman Paul Ryan gave a speech in January 2010 at Hillsdale College's Allan P. Kirby, Jr. Center for Constitutional Studies and Citizenship defining the role of government in a free society with particular reference to healthcare.

Paul Ryan understands the constitution and uses a lot of common sense.

Mr. Ryan traces the history of the progressive movement of the Democratic Party in America.

“The social and political programs of the Democratic Party’s progressive movement came in on two great waves: the New Deal of the 1930s and the Great Society of the 1960s”.

“Today, President Obama often invokes progressivism and hopes to generate its third great wave of public policy.”

This desire by President Obama leads him to believe he will be judged as one of the greatest Presidents in American history.

President Obama believes his ideology will save the healthcare system, the financial system, and the country.

There is no question the healthcare system needs to be reformed. It has become unaffordable and inaccessible to people who need healthcare insurance coverage.

The need for reform leads Dr. Don Berwick former Director of CMS to conclude that by definition effective healthcare system means the redistribution of wealth.

The debate in healthcare is not whether we need healthcare reform but what form that reform should take.

“Under the terms of our Constitution, every individual has a right to care for their health, just as they have a right to eat.”

“These rights are integral to our natural right to life. It is the government's chief purpose to secure our natural rights.”

But the right to care for one's health does not imply that government must provide health care, any more than our right to eat, in order to live, requires government to own the farms and raise the crops.

The government's chief purpose is to secure our natural rights. It is a critical sentence defining the role of government by our constitution.

It is not the role of government to provide healthcare any more than it is our right that the government feed us. It is the individual’s responsibility to do both.

It is the government’s obligation to protect our rights. The government’s obligation is to establish free market conditions so providers and vendors cannot take advantage of us and abuse our rights. We should not be entitled to food or healthcare.

Paul Ryan goes on to say,

“ With good reason, the Constitution left the administration of public health—like that of most public goods—decentralized.

If there is any doubt that control of health care services should not have been placed in the federal government, we need only look at the history of Medicare and Medicaid—a history in which fraud has proliferated despite all efforts to stop it and failure to control costs has become a national nightmare.”

All the stakeholders are experiencing this nightmare after 47 years of the government making adjustments to the Medicare and Medicare rules.

No one predicted the adjustments made by both the government and the stakeholders would result in unsustainable costs for the government, private sectors and the people.

This national nightmare is going to expand with the passage of Obamacare, the funding of the multiple agencies formed and the proposed 32 million more uninsured people to be added to Medicaid along with the increasing number of baby boomer going on Medicare.

Democrats, Republicans and Independents believe in fairness to all. Americans are very charitable people and are frequently mobilized to help the needy.

However, President Obama has tried to appeal to our sympathy for him by painting a contrast between himself and his opponents. He is trying to persuade us that he is the good guy and the rest are bad guys.

“If you believe this economy grows best when everybody gets a fair shot and everybody does their fair share and everybody plays by the same set of rules, then I ask you to stand with me for a second term as president.”

On closer examination his actions have gotten us deeper into our fiscal dilemma. He has not leveled the playing field; he has wasted money and increased our deficit. The U.S. is at the point where it cannot borrow itself out of its jam.

If the U.S. continues to try to print (money) itself out of the jam the economy will implode.

President Obama’s ideology has created uncertainty and decreased the private sector willingness to create jobs and stimulate the economy. He has not created enough jobs with his massive stimulus packages.

A reader wrote,

We ran out of money a long time ago. Every dollar we spend is 40% borrowed money and healthcare in our country is comprised of 50% taxpayer money. What else do we need to see in terms of the math to believe we are on an unsustainable path?

Paul Ryan argues,

“President Obama urges us today—out of compassion—to support the progressive model; but placing control of health care in the hands of government bureaucrats is not compassionate."

Bureaucrats don't make decisions about health care according to personal need or preference; they ration resources according to a dollar-driven social calculus.

Dr. Ezekiel Emanuel, one of the administration's point people on health care, advocates what he calls a “whole life system”—a system in which government makes treatment decisions for individuals using a statistical formula based on average life expectancy and “social usefulness.”

“ In keeping with this, the plans that recently emerged from Congress have a Medicare board of unelected specialists whose job it would be to determine the program's treatment protocols as a method of limiting costs.” (USPTF and IPAB)

I believe there are very few Americans who would be satisfied with this kind of halthcare system once they understand what is happening.

Ryan goes on to say:

"The good news is that we have a choice.

There are three basic models for health care delivery that are available to us:

(1) Today's business-government partnership or “crony capitalism” model, in which bureaucratized insurance companies monopolize the field in most states."

Medicare and Medicaid’s administrative services are outsourced to the healthcare insurance industry by the government. The healthcare insurance companies charge the government 40% of the Medicare and Medicaid healthcare dollars for overhead.

President Obama claims that the medical loss ratio will limit the overhead to 20% and 80% will go to direct medical care. Wrong!

The overhead is disguised in direct medical care costs.

How do you think top healthcare insurance executives can receive many millions of dollars in compensation each year?

"(2) The progressive model promoted by the Obama administration and congressional leaders, in which federal bureaucrats tell us which services they will allow."

We have seen over and over again unintended consequences, excessive waste created by cumbersome rules and regulations, and stakeholders adjustment to take advantage of the rules and regulations, all of which lead to intolerable costs, taxes and the erosion of the value of the dollar. Obamacare is going to result in greater administrative waste plus rationing of care.

" (3) The model consistent with our Constitution, in which health care providers compete in a free and transparent market, and in which individual consumers are in control."

The government's chief purpose is to secure our natural rights by leveling the playing field for all the stakeholders and enforcing the rules. It is essential that the rules are transparent and simple.

The patients must be empowered to be responsible for their healthcare dollars and their health. Entitlements do not promote personal responsibility

One of Paul Ryan’s concluding points is,

“The answer is that the current health care debate is not really about how we can most effectively bring down costs.”

It is a debate less about policy than about ideology. It is a debate over whether we should reform health care in a way compatible with our Constitution and our free society, or whether we should abandon our free market economic model for a full-fledged European-style social welfare state.

This, I believe, is the true goal of those promoting government-run health care."

My Ideal Medical Saving Account can be an extremely democratic and fair model. By changing a couple of existing healthcare insurance rules the administration would create a truly free competitive free market for healthcare consumption.

The government should also educate patients to assess the value of the medical care they freely choose. It should be the consumer’s decision, not the government’s decision.

These actions would reduce the cost of healthcare and create a sustainable healthcare system.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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